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Saturday, July 20, 2013

Yoga with hypermobility

The benefits of yoga have become so popularised these days that even my 5-year old niece can rattle a few of them off. But with that popularisation has also come a process of questioning whether yoga is really good for everyone, a discussion in part started by stories of yoga injuries. Generally we associate these yoga injuries with people who are stiff or inflexible trying to push or pull themselves into a pose; but what about the opposite? What about the people who are so flexible that they can fold in half without even trying?

What is hypermobility?

People whose joints have a more-than-normal range of motion are called hyperflexible or hypermobile - the clinical term is joint hypermobility syndrome (HMS), which may also be an expression of the more serious Ehlers Danlos Sydnrome. Research suggests that up to 3 in 10 adults may be hypermobile to some degree, with women being more likely to be affected than men due to the relaxing effects of female hormones. Many people with hypermobility have a 'harmless' variety: that is, they experience no unusual effects except being more bendy than the rest of us. But for others, HMS can be debilitating, causing chronic pain. In either case, people who are hypermobile are generally more prone to injuries, fractures and dislocated joints, because their joints have more mobility than stability.

Yoga and hypermobilility

Hypermobile people may come to yoga because of an injury, one of
those inexplicable "I was just walking/running/surfing/playing tennis
and then I felt this pain..." injuries that are common among the super-flexible. Or they naturally
gravitate to yoga because of their flexibility. Once in a yoga class, super bendy people are often told they are "amazing" by teachers who don't recognise or understand their hypermobility. Some may even quickly want to become teachers themselves, since after only a few months of practice they find themselves doing "advanced" poses with ease. And in a yoga culture that increasingly idolises the physical performance of postures that require extreme flexibility (just do a pinterest search for yoga if you don't believe me!), it may be hard for people to believe that extreme bendiness is not actually what yoga is all about.

However, underneath that ease in bending a hyper-flexible body is the danger that hypermobile joints are lacking the muscular resistance to properly support the joints in the range of motion that yoga puts us through. This may manifest slowly, through unexplained aches and pains after a seemingly "easy" practice; or it may manifest all of a sudden through an injury: a dislocated joint, a chronic pain, or a repeatedly inflamed muscle or tendon.

And yoga is not a miracle-cure: over time, the sustained practice of yoga without counter-balancing hyperflexibility can lead to a dangerous instability in the joints, that can manifest in chronic joint pain and even symptoms of early arthritis.

How can I tell if I'm hypermobile?

You may be hypermobile to some extent if any of the following sound familiar to you:

You have always been able to place your hands flat on the floor in a forward bend or flop into the splits

Your friends and family all remember your "crazy" flexibility as a child

You feel a constant need to stretch but it never seems to satisfy you

You are deep in a pose that is supposedly challenging, but you don't "feel" anything

After hardly any time at all, you put your body into the positions of 'advanced' yoga poses such as the splits, one-legged king pigeon pose, or touching your head to the ground in wide-legged standing forward bend

You find it hard to sit comfortably in a chair for a long time and are constantly folding yourself into different positions

In addition, you may be hypermobile in some joints while having a normal or less than normal range of motion in others.

So, should hypermobile people do yoga?

It's easy to understand why many doctors and physiotherapists who work with hypermobile people advise against doing yoga. However, many hypermobile people find that the right yoga practice can help them a great deal by building body awareness and helping them to develop the strength that they will need to balance their natural flexibility. The key thing to remember is that yoga is about balance: in this case, achieving a balance between flexibility and strength.

Guidelines for choosing a yoga class if you are hyper flexible:

Find an experienced and well-qualified teacher, preferably someone with some yoga therapy experience or someone familiar with hypermobility, and make them aware of what you are working with. Get them to help you create some goals for your practice that don't rely on flexibility alone.

Avoid styles of yoga that emphasise short, fast movements, such as ashtanga or vinyasa flow, until you have built up a solid foundation of strength that will keep you stable and safe from injury in these movement-oriented styles.

Instead, choose styles of yoga that emphasise proper alignment, stability and strength, such as Iyengar yoga or Viniyoga.

Complement your yoga with simple strength and resistance training, and with core strength building exercises like pilates (again, with an experienced teacher who understands hyper mobility) that will help you isolate important muscles and begin to build strength in key areas.

Some advice for practicing yoga if you are hypermobile:

If you can, see a qualified yoga therapist for a one-on-one session to get a personalised assessment and advice.

Avoid starting a practice on your own or with a DVD: until you have more experience, you should work with a teacher who can tell you if you are hyper-extending.

Don't move too quickly in and out of poses. Take your time to get into poses, making sure you are engaging your muscles during the transitions. For example in any forward bend, strongly engage your quadriceps and feel as if you are trying to "suck" the floor up through your leg muscles.

Once you are in a pose, avoid the temptation to go as deep as you can. Try practicing to the "80%" rule - only going 80% of the way into a pose, and stopping there to work on stability. Focus on engaging the muscles around your key joints: ankles, knees, hips, shoulders to make sure they are all strongly supported.

Make sure you always put a micro-bend in your knees and elbows to avoid putting too much stress on your joints - combine this with muscular engagement, and you will be properly supporting your joints!

Keep your head supported by your neck muscles, and avoid the temptation to let your head flop all the way back in upward-looking poses or backbends.

Consider 'gapping' your joints - for example placing a small rolled up towel in between your belly and your thighs in a standing forward fold, placing your hands behind the backs of your knees in a seated forward fold, keeping your feet on "railroad tracks" for Warrior I and other front-facing poses.

I'm glad I read your post a few months ago. There was a girl in my class tonight and I was able to recognise her hypermobility. I referred a girl to your post to help her understand her practice. Thank you!

Thank you. I have Ehlers Danlos Syndrome. A sciatica article led me here. It's so sad that many of my friends with this genetic syndrome are told to stop doing yoga. I certainly believe it's necessary. I couldn't physically withstand living with EDS unless I did yoga several times a day. It needs to be done right. I appreciate this. In health, Jac

Hi. Thanks so much for this article. I don't have EDS but I am hypermobile. Iyengar yoga has been incredible for me-many of the aches and pains I had starting in my 30s disappeared after I started Iyengar. That being said, I do have a tendency to overextend, especially in the shoulders, and have caused some minor injuries in the process, but these experiences have been useful in teaching me to faithfully observe the 80% rule!

I wanted to comment that I have noticed that my female Iyengar instructors are far more likely to notice my hypermobility, and address with helpful corrections and suggestions. I suspect this is because women are far more likely to be hypermobile and therefore are more sensitive to it in their students.

Your observation that your female teachers are more attuned to your hyper mobility is also interesting. I wonder if many male teachers perceive women to be more 'naturally flexible' and therefore are not as aware of the possibility of their hyper flexibility? That said, I have worked with men who have hyper flexible joints as well. At the end of the day it really all comes down to the individual.

Great article! I have EDS (hypermobile type) and was told to stop doing yoga over a year ago...I miss it (and my sculpted arms) so much and am happy to read that there are ways to work around it. I will check out Iyengar as opposed to my previous Vinyasa. Thanks so much for this info!

This article reinforces everything that I have thought on the matter of yoga + hypermobility. My boyfriend is in constant pain and discomfort along with a slew of other problems caused by hypermobility and I've convinced him that yoga may help, but this has the both of us sold. Thank you so much for this post! :)

Great article. I am hyper mobile and your article almost exactly describes my 10 year love/hate relationship with yoga. Teacher's comments on my amazing bridge pose. One teacher telling me that the pain I felt in forward bend might be because I was "near a breakthrough". And then the ultimate destination...two frozen shoulders. After two years off from yoga, I'm starting again slowly and with a one-on-one consultation with an experienced teacher. And weekly PT sessions. All to see if I can get rid of the daily joint pain and get my arm ROM back. Thanks!

And yes just what I did 2 years ago... youtube videos. The poses were so easy to get into then I signed up with a yoga teacher after I pulled my back going from cobra to dog... but she had no idea. After 2 years I feel pain in my shoulders, lower back, hips, wrists and elbows.. just wish I'd known earlier yoga is not only about flexibility. Now I train like an old lady to build up muscles so I can go back to yoga which helped me so much to relax just not sure if it will be ever possible. Thank you for the article!

Yes, it's such a misconception that yoga is all about flexibility. In fact, it's about balancing strength and flexibility - and basically, that means hard work, every day, for the rest of your life! No easy way out - but the results are worth it. Take heart - a balanced routine of strengthening and stretching can achieve wonders. Also, don't shy away from plain old relaxation through savasana, yoga nidra, or a guided meditation!

I would just like to ask, ia hyperflexibility the same as htper mobility? Also i read somewhere that you must be hyperflexible to become a contorionist. I did not find this encouraging because i would like to become one one day but am not hyperflexible...Thanks, Lily

I am 28 years of age and have recently been diagnosed as having hypermobility. I was able to do the splits (scissors) by age 4 and backbends by age 6 easily with no pain or effort. I was a chubby child and found that didn't hinder my twisting, bending abilities. I had trouble with 'growing pains' all through my teens. I hated sports and now look back and remember being injured easily and sat out for most lessons. Sitting cross legged is my preferred rest position, i like to lean forward and rest my head in my hands, and I am not a sitting person, I need to be up moving.

Around 5 years ago I developed a grinding and strange movement in my left hip, I diagnosed it myself as 'overdoing' it, It appeared after walking around 6kms. I always had the need to stretch. Then a year after that my left knee was giving my the grief. No doctor could tell me why, I had x-rays, ultrasounds and CT scans on it, nothing was unusual. I decided to take on a gluten free diet with glucoseamine fish oils, made a huge improvement.

In 2012 I was thrown from a horse, landed on my bum and shattered my T12. I luckily had my cord intact and was able to walk, although had extreme pain which has eased over time since.

Last November, whilst doing some gardening, was in a squat pose, went to stand up and dislocated my knee, so sudden and shocked I was, I went to emergency and was asked if I was aware of having loose joints and hypermobility. Never heard of it, was sent to have a check up with a physio specialist. Thats when I found my problem! I was asked to place my palms on the ground in front of my feet- so I did, i can bend my thumb to my wrist and I can lift my left leg over my head... I also enjoy chewing my toenails hahaha.

With having a compressed spine and hypermobility I have gained a lot of weight and a load of unhappiness to go with it. From being so active before this its hard to know what I can do to keep my muscles and joints, flexible yet stable. Any advice on where to go from here. I have a 1200 cal a day diet, I am gluten free and walking is the majority of my exercise, except for some stretching.

About Me

I am a passionate student and practitioner of yoga, a 500-hour certified teacher, and I'm currently working towards a Graduate Certificate in Yoga Therapy.
However, ONLY YOU truly know yourself and your body. In practicing any of the poses or sequences shown on the blog, please use self-awareness, caution, and self-respect. Remember: you are your own best teacher!